Background information

Homeopathic and herbal health care products are very popular in France. The most popular forms of complementary/alternative medicine are, in order of popularity, homeopathy, acupuncture, herbal medicines, water cures, chiropractic, thalasso-therapy, osteopathy, and iridology (172).

Statistics

A 1987 survey found that 36% of allopathic doctors, mostly general practitioners, used at least one complementary/alternative technique in their medical practices. Among allopathic physicians using complementary/alternative medicine, 5.4% used it exclusively; 20.7%, often; and 72.8%, occasionally. The social security system qualifies allopathic physicians using complementary/alternative medicines as "doctors with a particular type of practice (MEP)". Any doctor can be so designated. In 1993, physicians who were registered as MEPs represented 6.2% of the whole medical corpus. Thirty per cent of MEPs provide acupuncture treatments. Twenty per cent provide homeopathic therapies (172).

An additional 50 000 non-allopathic practitioners provide complementary/alternative therapy in France (172). There are approximately 390 chiropractors practising in France (65). There are between 2000 and 4000 kinesiotherapists (172).

One survey (172) found 49% of the people questioned - 53% of the women surveyed and 44% of the men - had used complementary/alternative medicine at least once, 16% during the previous year. Complementary/alternative medicine is most popular among people between the ages of 35 and 45,59% of persons in this age group having reported using complementary/alternative medicine. Sixty-eight per cent of executives and academics had used complementary/alternative medicine, compared to 60% of middle managers and intermediate professionals and 40% of farmers, the least likely group to use complementary/alternative medicine. Those surveyed reported using a complementary/alternative medicine for minor diseases (49%), chronic symptoms (54%), serious illnesses (3%), and the prevention of disease and promotion of a healthy lifestyle (17%).

Seventy per cent of patients of complementary/alternative medicine considered it effective for minor diseases; 65%, for chronic diseases; and 9%, for serious illnesses. Only 11% of patients considered these therapies ineffective for minor diseases; 15%, for chronic diseases; and 38%, for serious illnesses (172).

France has many organizations for practitioners and patients of complementary/alternative medicine.

Regulatory situation

Under Articles L 372 through L 376 of the Code of Public Health (172), persons other than licensed allopathic physicians who habitually or continuously diagnose or treat illnesses, real or supposed, or who perform activities constituting medical procedures are illegally practising medicine. Persons wishing to obtain a licence to practise medicine must possess a State certificate; hold French, Tunisian, Moroccan, or European Union citizenship; and be registered by the professional society of physicians.

Despite prosecution, non-allopathic practitioners - particularly physiotherapists using complementary/alternative methods such as chiropractic and osteopathy - continue to practise, and the number of allopathic physicians using complementary/alternative medicine is increasing. Allopathic physicians providing complementary/alternative treatments either assist persons practising medicine illegally or practice complementary/alternative medicine themselves. In both cases, they risk being tried for penal and disciplinary infractions. Recent decisions, however, suggest that the courts are becoming more tolerant towards the practice of complementary/alternative medicine.

Education and training

Teaching complementary/alternative medicine (172) to non-allopathic physicians is permitted. The number of schools and courses in complementary/alternative medicine has recently increased, although they vary widely in quality. Private schools, however, may not issue diplomas to their graduates. According to Article 4 of the Act of 18 March 1880, only the State has this power.

Despite the allopathic medical establishment's opposition to the recognition of chiropractic, the Decree of 11 February 1953 provides for the incorporation of chiropractic into medical schools. However, the Decree has not been applied and chiropractic has never been taught in French medical schools. In fact, the practice of chiropractic is illegal in France. Nonetheless, there is a school of chiropractic (65).

The University of Bobigny (172) established the Department of Natural Medicines in 1982. Since then, diplomas have been awarded in acupuncture, homeopathy, phytotherapy, osteopathy, auriculotherapy, naturopathy, oligotherapy, and mesotherapy.

In 1990, the University Diploma in Natural Medicines (172) - training leading to an inter-university certification recognized by the French National Order of Physicians - was created for acupuncture and osteopathy. Recognition of a certification in homeopathy is under consideration. Phytotherapy is already incorporated into training in pharmacy. However, these therapies are not considered medical specialities. In order to obtain recognition as a medical speciality, the discipline must be taught according to the criteria followed for an allopathic speciality, i.e., the training should be full-time and include periods of clinical practice.

Some non-allopathic practitioners receive their training at foreign schools. For example, kinesiotherapists/physiotherapists who also provide chiropractic treatments are usually trained in the United Kingdom or Germany (172).

Insurance coverage

In France, social security and private insurance (172) reimburse some forms of complementary/alternative medicine so long as an allopathic medical practitioner provides them.

Social security reimburses homeopathic prescriptions written by authorized physicians and specific medical activities and products, including chiropractic, medical phytotherapy consultations, and complementary/alternative technical sessions with an approved kinesiotherapist. Acupuncture treatments given by MEP physicians are also reimbursed, provided that the physicians observe regulations regarding allopathic consultations.